Method and system for measuring pressure in a body cavity

ABSTRACT

According to one embodiment, a method includes positioning a portion of a trocar into a patient cavity and inserting a surgical instrument into the trocar. The method also includes measuring, by a pressure sensor disposed in, on, or through a medical appliance, a pressure indicative of a pressure in the patient cavity. The method also includes supplying, based at least in part on the measured pressure, an insufflation gas to the patient cavity by providing the insufflation gas through the trocar.

RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.15/251,511, filed Aug. 30, 2016, and entitled, “Method and System forMeasuring Pressure In a Body Cavity,” which is hereby incorporated byreference herein.

TECHNICAL FIELD

The present disclosure relates generally to medical procedures and moreparticularly to a method and system for measuring pressure in a bodycavity using a trocar.

BACKGROUND

Laparoscopic surgery is a standard procedure in hospitals. Abdominal andchest cavity operations are being performed with instruments insertedthrough small incisions into interior portions of the body. Suchlaparoscopic procedures are now considered the treatment of choice foroperations such as the removal of the gall bladder, spleen, adrenalglands, uterus, and ovaries. These laparoscopic procedures areaccomplished via access through a device typically known as a trocar.

A trocar facilitates the introduction of laparoscopic instruments intothe abdomen or chest of the body. These instruments are typicallyintroduced into regions under fluid pressure. Providing a fluid into abody cavity is referred to as insufflation and the fluid, often a gas,is referred to herein as an insufflation gas. The purpose of using sucha device is to inflate or distend the body cavity to (1) allow thesurgeon to explore the area in which the surgery will be performed and(2) provide a view of the site to be treated or observed. These trocarstypically also allow for the insertion of an instrument via theinnermost tube of the trocar. Examples of one or more trocars areprovided in U.S. Pat. No. 8,715,219 (the '219 Patent), U.S. Pat. No.7,285,112 (the '112 Patent), and U.S. Pat. No. 8,216,189 (the '189Patent), which are hereby incorporated by reference as if fully setforth herein.

Currently, insufflation is performed by providing a regulatedpressurized insufflation gas to the peritoneal cavity via a cannula ofthe trocar. This insufflation gas, typically carbon dioxide, is suppliedto a connection on the trocar tube by a flexible hose attached theretoby an insufflator. Accurate control of the pressure inside the bodycavity is important because it can prevent loss of visualization thruthe scope during the surgical procedure. Loss of visualization can slowdown the surgery and is also potentially dangerous for the patient asthe sharp surgical instruments can no longer be seen by the surgeon.

SUMMARY

According to one embodiment, a method includes positioning a portion ofa trocar into a patient cavity and inserting a surgical instrument intothe trocar. The method also includes measuring, by a pressure sensordisposed in, on, or through a medical appliance, a pressure indicativeof a pressure in the patient cavity. The method also includes supplying,based at least in part on the measured pressure, an insufflation gas tothe patient cavity by providing the insufflation gas through the trocar.

According to another embodiment, a trocar assembly includes an innertubular member formed with an opening adapted to provide access for oneor more surgical instruments during a surgical procedure, an outertubular member disposed about the inner tubular member, and a pressuresensor disposed in, on, or through a medical appliance, the pressuresensor being operable to measure a pressure indicative of a pressure ofa body cavity.

The teachings of the disclosure provide one or more technicaladvantages. Embodiments of the disclosure may have none, some, or all ofthese advantages. For example, in some embodiments, a method andapparatus for measuring pressure in a patient cavity is provided thatallows more accurate assessment of the pressure in a patient cavity dueto in part to the proximity of the pressure sensor to the patientcavity. Also, it is out of the gas flow stream which can createinaccurate pressure readings.

Other advantages will be apparent to those of skill in the art.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of embodiments of the disclosure andthe potential advantages thereof, reference is now made to the followingwritten description taken in conjunction with the accompanying drawings,in which:

FIG. 1A is a schematic diagram illustrating the control of pressure in abody cavity according to a traditional approach, and FIG. 1B is a graphillustrating pressure versus time for an example operation of the systemof FIG. 1A;

FIGS. 2A and 2B are schematic diagrams of a system for measuringpressure in a body cavity using a trocar;

FIG. 3 is a cross sectional diagram of an alternative embodiment of thesystem of FIGS. 2A and 2B, showing an example cross section of a trocar;

FIGS. 4A and 4B illustrate an alternative embodiment of a system formeasuring pressure in a body cavity using a trocar with an outer tubularmember having first and second channels; and

FIG. 5 is a flow chart illustrating a method for measuring pressure in abody cavity using a trocar.

DETAILED DESCRIPTION OF THE DRAWINGS

The teachings of the present disclosure recognize that controllingpressure in a body cavity may be effected more advantageously bymeasuring a pressure through a pressure sensor disposed within a trocardisposed within the body cavity and providing the measured pressure to acontroller that can appropriately supply pressurized insufflation fluidto the body cavity. Measuring pressure using a pressure sensor disposedwithin the trocar provides a more accurate indication of the pressure inthe body cavity and can alleviate pressure control problems that may beexperienced through other techniques. Example embodiments are bestunderstood by referring to FIGS. 1A through 5 of the drawings and thedescription below, like numerals being used for like and correspondingparts of the various drawings.

FIG. 1A is a schematic diagram illustrating the control of pressure in abody cavity according to a traditional approach, and FIG. 1B is a graphillustrating pressure versus time for an example operation of the systemof FIG. 1A. FIG. 1A shows an insufflator 10 connected to a patient, orbody, cavity 20 through conduit 12 and a trocar 14. FIG. 1A alsoillustrates an alternative conduit 18, through which pressure can bemeasured.

It is desirable to control the pressure within body cavity 20, referredto as Pc, during an operation. One traditional approach for suchpressure control is to provide an insufflation gas to body cavity 20 byinsufflator 10, through conduit 12 and trocar 14. In someimplementations, insufflator 10 operates on an on/off basis, and thepressure Pc in body cavity 20 is desirably controlled based on theactual pressure Pc in body cavity 20. The traditional control approach,however, is to control supply of insufflation gas from insufflator 10 tobody cavity 20 based on a pressure P1, measured at insufflator 10. Thispressure P1 is the pressure where conduit 12 meets insufflator 10, andthus serves as a proxy for pressure Pc in patient cavity 20. Due topressure losses between insufflator 10 and patient cavity 20, themeasured pressure P1 is not the same as the actual pressure Pc inpatient cavity 20, particularly since pressurized insufflation gas isprovided by insufflator 10 through conduit 12. As an alternativetraditional method, separate conduit 18 is used to measure P2, which isthe pressure where conduit 18 meets insufflator 12. Unlike conduit 12,pressurized insufflation gas is not provided through this conduit 18.Thus, P2 is a better indication of the pressure Pc in patient cavity 20than P1 is. Nevertheless, both approaches are not as accurate as may bedesired and can lead to undesirable results, such as those shown in FIG.1B. Further, pressure control can become inaccurate or inoperable ifconduit 18 becomes clogged or disconnected.

In FIG. 1B, pressure fluctuations over time are shown that can resultfrom both of these traditional control procedures. These fluctuationsoccur due to differences between the actual Pc in body cavity 20 and P1and P2. At high leak rates in the patient cavity they can prevent lossof visualization thru the scope during the surgical procedure. Loss ofvisualization can slow down the surgery, and is also potentiallydangerous for the patient as the sharp surgical instruments can nolonger be seen by the surgeon.

According to the teachings of the present disclosure, better pressurecontrol of the pressure in a patient or body cavity can be achievedthrough use of a pressure sensor disposed in a trocar in the patientcavity, such as trocar 16. Disposing a pressure sensor in the trocarallows measurement of pressure at a location much closer to the patientcavity and therefore provides a better basis for determining the actualpressure in the patient cavity, and thus better pressure control.

FIGS. 2A and 2B illustrate one embodiment of a system 100 forcontrolling pressure Pc in a patient or body cavity 120. System 100includes a trocar 116, an insufflator 110, a conduit 175 for supplyinginsufflation gas to a portion of trocar 116, a pressure sensor 180disposed within trocar 116, and a conductive connection 182, providingan electrical connection between pressure sensor 180 and insufflator110. A distal end 184 of trocar 116 is inserted into patient cavity 120while the proximal end 122 allows an instrument 124 to be inserted suchthat trocar 116 provides access to body cavity 120 for the instrument124. Suitable seals may be positioned in or around trocar 116 forpreventing or reducing leakage of fluid out of trocar 116. Patientcavity 120 may be accessed through an incision made with an obturator,which may be included in the same kit or package with trocars describedherein.

Trocar 116 is formed with an inner tubular member, or inner lumen, 108and an outer tubular member, or outer lumen, 110 in this embodiment.However, trocars without separate inner and outer lumens may also beused. Inner lumen 108 is separated from outer lumen 110 by an inner wall125. Outer lumen 110 is surrounded by an outer wall 118. Outer wall 118may be formed with one or more holes or apertures 114 near a distal end162 of trocar 116. Insufflator 110 is a source of insufflation gas andmay include appropriate control functionality for adjusting the supplyof insufflation gas, such as in response to receiving signals indicativeof the pressure in the body cavity. A surgical instrument 124 may bepositioned within inner lumen 108 to allow access to patient cavity 120by a surgeon using surgical instrument 124. Electrical connection 182,which may be an electrical wire or any other suitable form of electricalconnection, can be disposed in any suitable location within trocar 116,including in inner lumen 108 or outer lumen 110. Placement of electricalconnection 182 primarily within outer lumen 110 provides an additionaladvantage of protecting electrical connection 182 from possible damageby instrument 124.

According to the operation of one embodiment, insufflation gas 102,which in one embodiment is carbon dioxide, is delivered by insufflator110 to patient cavity 120 through conduit 175 and outer lumen 110, asindicated by arrows 112. Insufflation gas 102 enters patient cavity 120via apertures 114 in outer wall 118 of the trocar 116. Pressure ismeasured by pressure sensor 180 within inner lumen 108 of trocar 124,providing an approximation of the pressure Pc within body cavity 120.The measured pressure is communicated to insufflator 110 throughelectrical connection 182 through outer lumen 110, in this example. Inone embodiment, pressure sensor 180 electrically couples to electricalconnection 182 through apertures, although other forms of electricalcoupling may be used, including wireless coupling. Based on the measuredpressure, insufflator 110 may adjust the pressure Pc in body cavity 180by, for example, providing or not providing additional insufflation gas102 to body cavity 120 or by adjusting the pressure or valve flow atwhich insufflation gas 102 is provided by insufflator 110. Any desiredform of control may be used by insufflator, including on/off control, P,P-D, and P-I-D control approaches. By measuring the pressure near thebody cavity Pc through a pressure sensor disposed within trocar 116,better control of the pressure within body cavity 120 can be achieved,and undesirable cycling such as that shown in FIG. 1B can be reduced.

Additional details and embodiments of systems and methods for providingpressure control of the pressure in a patient cavity are describedbelow. FIG. 3 illustrates example details of portions of the system ofFIGS. 2A and 2B, according to one embodiment. FIGS. 4A and 4B illustratean alternative embodiment of a system for measuring pressure in a bodycavity using a trocar with an outer tubular member having first andsecond channels, while FIG. 5 illustrates a method for controllingpressure in a body cavity.

FIG. 3 is a cross sectional diagram near the distal end 184 of oneembodiment of a trocar 216 that may be used in the system of FIGS. 2Aand 2B. Similar parts to those of trocar 116 have like referencenumerals. As illustrated, trocar 216 includes at least one cutout region218 into which pressure sensor 180 may be disposed. Placement ofpressure sensor 180 in cutout region 218 protects pressure sensor 180from damage that may occur when an instrument, such as instrument 124,is placed within inner lumen 108 of trocar. In this example embodimentcutout region 218 also protrudes into an area where the outer lumen 110would otherwise be formed. The dotted line 224 forming part of cutoutregion 218 represents the missing portion of a generally circular innerlumen that would be formed without cutout region 218. Thus, this is oneexample of a configuration of cutout region 218 in which disposingpressure sensor 180 within cutout region 218 would make pressure sensor180 generally inaccessible to an instrument 124 with a generally crosssectional area to protect pressure sensor 180 from damage. The cutoutregions 218 also ensure that the obturator and/or instruments do notclose off the inner lumen 108 from being in intimate contact with thebody cavity 120.

In this embodiment, passages 220 between inner lumen 108 and outer lumen110 are provided to allow gas flow in the event that inner lumen 108becomes blocked, as indicated by arrows 117. The passages 220 andcutoffs 218 prevent closing off the pressure sensor from the body cavity120.

FIGS. 4A and 4B illustrate another embodiment of a system 300 forcontrolling pressure Pc in a patient cavity 320 that uses a trocarhaving an inner lumen and an outer lumen with a plurality of chambers.System 300 is analogous to system 100, including a trocar 316, aninsufflator 310, a conduit 312 for supplying insufflation gas to aportion of trocar 316, a pressure sensor 380 disposed within trocar 316,and a conductive connection 382, providing an electrical connectionbetween pressure sensor 380 and insufflator 310, with analogous portionsof system 100 and system 300 having like reference numerals but trocar316 is analogous to trocar 116, with analogous portions having analogousreference numerals, except that trocar 316 is formed with an inner lumen308 and an outer lumen 310 having a plurality of chambers 330, 332.Outer wall 318 is formed with one or more holes or apertures 314 near adistal end 362 of trocar 306 that are associated with chamber 330. Outerwall 118 may also be formed with one or more holes or apertures 315proximate distal end 362 of trocar 306 that are associated with chamber332. Conductive connection 382 may be disposed primarily in chamber 330,332 of out lumen 310, in inner lumen 308, or in other suitablelocations.

Providing separate chambers 330 and 332 in outer lumen 310 allowsplacement of pressure sensor 380 in one of the outer chambers 330, 332and allows supplying insufflation gas in the other outer chamber 330,332. This protects pressure sensor 380 from damage that couldpotentially be caused by instrument 124 due to insertion into innerlumen 108, while at the same time isolates pressure sensor 380 fromsupplied insufflation gas 312, which might otherwise adversely affectthe accuracy of the pressure measured by pressure sensor 380. Ingeneral, measuring pressure by pressure sensor 380 in a location withintrocar 380 that does not also provide a conduit for insufflation gasallows a more accurate estimation of Pc in patient cavity 320 becauseflow of gas creates a pressure drop along its path. This pressure droprequired for gas to flow would create inaccurate pressure readings atthe pressure sensor 380.

FIG. 5 is a flowchart illustrating a method of controlling pressure in apatient cavity. At step 410, a trocar is disposed into a patient cavity.In some embodiments, the trocar may be formed with an inner tubularmember and an outer tubular member. In some of these embodiments, theouter tubular member may be formed with multiple separate chambers andin some embodiments the outer tubular member has only one distinctchamber. A pressure sensor is located within the trocar. In someembodiments the pressure sensor may be located in the inner tubularmember or the outer tubular member. In some embodiments the pressuresensor is located near a distal end of the trocar, near the patientcavity, and also located in a location inaccessible to a surgicalinstrument that is inserted into the inner tubular member. At step 420,the surgical instrument is inserted into the trocar. At step 430, apressure is measured by the pressure sensor disposed within the trocar,which is indicating of a pressure in the patient cavity. At step 440,based at least in part on the measured pressure, an insufflation gas issupplied to the patient cavity by providing the insufflation gas throughthe trocar. In one example, the pressure in the patient cavity can beincreased by supplying more insufflation gas or by supplyinginsufflation gas at a higher pressure. Conversely, the pressure inpatient cavity can be reduced by halting or reducing the flow ofinsufflation gas or by reducing the pressure at which the insufflationgas is supplied. The above steps may be performed in any desired orderand may not necessarily be performed sequentially. For example, thepressure may be measured before, after, and/or during insertion of thesurgical instrument. As another example, insufflation gas may besupplied before, during, and/or after pressure measurement.

Thus, the systems of FIG. 2A through 5 provide more accurate control ofpressure in a patient cavity through use of a pressure sensor disposedwithin a trocar.

Additional details of systems 100 and 300 are described below forinsufflation gas 102, insufflation gas source 170, trocars 116 and 316,open gas tubing connection 120, connection 164, conduit 175, conduit185, and surgical instrument 124.

Insufflation gas 102 may be any suitable gas used for insufflationpurposes. In one example, insufflation case is carbon dioxide.Insufflation gas source 170 may be any suitable source of insufflationgas 102 at any suitable pressure.

Trocars 116, 216, and 316 may be any suitable as described herein. Alltrocars described herein may be open or closed at the distal end, as theapplication of the trocar would allow. Further, the trocars may or maynot include apertures in their inner wall separating the outer lumenfrom the inner lumen. Further, all trocars described herein may beformed according to features described in the '219 Patent, the '112Patent, and/or the '189 Patent. Further, trocars 116 and 316 may beformed with a heater and/or humidifier therein.

Conduit 175 may be any suitable conduit for providing an insufflationgas to a portion of a trocar. An example of conduit 175 includesflexible PVC tubing.

Conduit 185 may be any suitable conduit for providing a vacuum to aportion of a trocar. An example of conduit 185 is flexible PVC tubing.

Surgical instrument 124 may be any suitable instrument that may be usedin surgery, including an obturator used to make an incision to obtainaccess to a body cavity.

Modifications, additions, or omissions may be made to systems 100, 300without departing from the scope of the invention. The components ofthese systems may be integrated or separated. Moreover, the operationsof these systems may be performed by more, fewer, or other components.

Although FIGS. 2A through 5 have been described above as includingparticular steps and/or components, the method and systems of theseFIGURES may include any combination of any of the described steps and/orcomponents and any of the options or features described herein, as wouldbe understood by one of ordinary skill in the art. For example, any ofthe steps, options, or features described herein may be utilized incombination with the illustrated embodiments of FIGS. 2A through 5and/or any number of the other steps, options, or features alsodescribed herein, as would be understood by one of ordinary skill in theart.

Although the embodiments in the disclosure have been described indetail, numerous changes, substitutions, variations, alterations, andmodifications may be ascertained by those skilled in the art. It isintended that the present disclosure encompass all such changes,substitutions, variations, alterations, and modifications.

What is claimed is:
 1. A method comprising: positioning a portion of atrocar into a patient cavity, the trocar comprising an inner tubularmember and an outer tubular member disposed about the inner tubularmember; inserting a surgical instrument into the inner tubular member ofthe trocar; measuring, by a pressure sensor disposed in either the innertubular member or the outer tubular member a pressure indicative of apressure in the patient cavity, wherein the pressure sensor ispositioned such that it is not in a gas flow channel of the trocar; andsupplying, based at least in part on the measured pressure, aninsufflation gas to the patient cavity by providing the insufflation gasthrough the outer tubular member of the trocar.
 2. The method of claim1, wherein: measuring the pressure indicative of the pressure in thepatient cavity comprises measuring the pressure through a first chamberof the outer tubular member; and supplying insufflation gas to thepatient cavity further comprises supplying the insufflation gas througha second chamber of the outer tubular member.
 3. The method of claim 1,further comprising disposing the pressure sensor within a cutout regionof the inner tubular member.
 4. The method of claim 1, furthercomprising controlling the pressure in the patient cavity based on thepressure measured by the pressure sensor.
 5. The method of claim 4,wherein controlling the pressure in the patient cavity comprisesmaintaining a substantially constant pressure in the patient cavity. 6.The method of claim 1, further comprising electrically connecting thepressure sensor to an insufflator for supplying the insufflation gas tothe patient cavity, the electrical connection comprising a cable.
 7. Themethod of claim 6, further comprising threading the cable through theouter lumen of the trocar.
 8. The method of claim 1, further comprisingallowing the insufflation gas to flow into the patient cavity viaapertures in a side wall of the outer tubular member.
 9. The method ofclaim 1, further comprising allowing insufflation gas to flow betweenthe inner and outer tubular members via apertures in a side wall of theinner tubular member.
 10. A method comprising: positioning a portion ofa trocar into a patient cavity; inserting a surgical instrument into thetrocar; measuring, by a pressure sensor disposed inside of a medicalappliance a pressure indicative of a pressure in the patient cavitywherein the pressure sensor is positioned such that it is not in a flowchannel for insufflation gas; and supplying, based at least in part onthe measured pressure, an insufflation gas to the patient cavity byproviding the insufflation gas through the trocar.
 11. The method ofclaim 10, wherein the trocar comprises an inner tubular member and anouter tubular member disposed about the inner tubular member; insertingthe surgical instrument into the trocar comprises inserting the surgicalinstrument into the inner tubular member; measuring the pressurecomprises measuring a pressure within the inner tubular member; andsupplying the insufflation gas comprises supplying the insufflation gasthrough the outer tubular member.
 12. The method of claim 11, allowingthe insufflation gas to flow into the patient cavity via apertures in aside wall of the outer tubular member.
 13. The method of claim 11,allowing insufflation gas to flow between the inner and outer tubularmembers via apertures in a side wall of the inner tubular member. 14.The method of claim 10, further comprising providing the pressure sensorinside of the trocar, the trocar being the medical appliance.
 15. Themethod of claim 14, further comprising disposing the pressure sensor ina portion of an inner tubular member that is not accessible by thesurgical instrument, the inner tubular member being disposed within anouter tubular member.
 16. The method of claim 15, further comprisingdisposing the pressure sensor within a cutout region of the innertubular member.
 17. The method of claim 10, further comprising disposingthe pressure sensor in a first chamber of an outer tubular member of thetrocar, the outer tubular member being disposed about an inner tubularmember; and supplying the insufflation gas through a second chamberportion of the outer tubular member.
 18. The method of claim 10, furthercomprising electrically connecting the pressure sensor to an insufflatorfor supplying the insufflation gas to the patient cavity, the electricalconnection comprising a cable.
 19. The method of claim 10, furthercomprising controlling the pressure in the patient cavity based on thepressure measured by the pressure sensor.
 20. The method of claim 19,wherein controlling the pressure in the patient cavity comprisesmaintaining a substantially constant pressure in the patient cavity.